Uterine Cancer
Introduction
Cancers of the uterus (womb) usually begin in the cells which make up the lining of the uterus. This lining is called as the endometrium.
Cancers of the uterus are often called as endometrial cancer because this term helps to distinguish them from other cancers that also affect the female reproductive system, such as cervical cancer or ovarian cancer.
The uterus and the endometrium:
The uterus is the part of the female reproductive system where the embryo is implanted and baby is carried during pregnancy.
The uterus is lined by a layer of cells called the endometrium. The cells of the endometrium are regularly discarded or shaded during a woman’s monthly period and are then replaced by new cells.
Obesity is a major risk factor for endometrial cancer. The number of cases of endometrial cancer is about 10 times higher in affluent countries than in the developing world.
Types of endometrial cancer
There are two main types of endometrial cancer:
Type 1 endometrial cancer –this is a slow-growing cancer and it is thought to be linked to the female hormone oestrogen. This cancer accounts for about 80 % cases.
Type 2 endometrial cancer– this is a more aggressive, faster-growing form of cancer that does not appear to have any connection to oestrogen. Type 2 endometrial cancer accounts for around 10% of cases.
Apart from type 1 and 2 of endometrial cancer, there are several rare types of cancers of the uterus. Endometrial cancer is more common in women who have been through the menopause.
Incidence- Endometrial cancer is the most commonly occurring cancer of the female reproductive system. It is the fourth most common cancer which affects women, after breast cancer, lung cancer and cancer of the colon and rectum.
Endometrial cancer is more common in women who have been through the menopause. Thus, most cases of endometrial cancer are diagnosed in women aged over 50.
Obesity is a major risk factor for endometrial cancer. The number of cases of endometrial cancer is about 10 times higher in affluent countries than in the developing world.
As with most types of cancer, the prognosis or outlook depends largely on how advanced is the stage of the cancer at the time it is diagnosed and the age of patient at diagnosis. Five year survival rate for early-stage type 1 endometrial cancer is about eighty-five per cent. This means that women diagnosed with this type of cancer will be alive five years after diagnosis.
A staging system is used by the medical professionals to describe how far endometrial cancer has advanced. These stages are:
• Stage one: the cancer is still contained inside the uterus.
• Stage two: there is spread of cancer to the neck of the womb (the cervix).
• Stage three: the cancer has spread outside the womb into nearby pelvic tissues or the lymph nodes.
• Stage four: the cancer has spread to the bladder or bowel, or to other distant parts of the body (metastasis) such as the liver or lungs.
Treatment:
Endometrial cancer can be treated surgically by removing the womb, which is called as hysterectomy. Radiotherapy and chemotherapy are also sometimes used after surgery to reduce the risk of the cancer recurrence. Chemotherapy is sometimes given before surgery to reduce the size of the tumour in case of large tumours.
People with cancer need to be cared for by a team of specialists who work together to provide the best treatment and care. This approach can address all the issues regarding endometrial cancer.
The team often consists of specialist cancer surgeon (gynaecological oncologists), a medical oncologist or a chemotherapy specialist and a specialist nurse. Other members may include a radiologist, pathologist, physiotherapist, a dietician and an occupational therapist.
For deciding what course of treatment is best suitable for a particular woman, the doctors will consider:
• The stage of the cancer (size of the tumour and how far it has spread)
• General health of the patient
• Whether preservation of fertility is a matter of concern (this is rare as the endometrial cancer usually occurs after menopause)
The main treatments for endometrial cancer are:
• Surgery
• Radiotherapy
• Chemotherapy
These modalities of treatment are given alone, or a combination. This choice depends mainly on the stage of uterine cancer. Before going to hospital to discuss the treatment options, it can be useful to write a list of questions to be asked to the specialist. Each of these treatments has advantages and disadvantages of its own.